How to prevent and treat achilles tendon injuries in runners

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Are Achilles injuries common in runners?

The demands of strength and elasticity of the set of leg muscles, especially the posterior face, which come together to form the calcaneal tendon or also known as achilles tendon, are very high in athletes, and especially in runners.

Depending on the distances, pace, types of terrain, type of footwear, and even way of running, we will make a greater demand for these structures when we carry out our training or activity.

If we make a greater effort than the one produced by our muscles we will find musclesions,because of insufficiency of this, with pain, ramps and a series of discomforts that will make it difficult for us to continue with the effort. If we lack elasticity, sensations of tension, increased tension, which are usually associated with fibrillary breakswill be added.

In those cases, does the Achilles break?

Achilles ruptures are related to two situations of muscle and tendon fibers. They are usually produced in tendons with some degree of degeneration,which can be per tendon of repeated, with presence of calcifications or more frequently with microcalcifications, and a lack of elasticity of such fibers. The paradox is that many of those lesions that can lead to tendinopathes occur because we do not work enough the elasticity of the tendon, and instead we do subject it to more strength.

When does the Achilles break?

Most Achilles breaks occur almost cold. An effort over said in unstretched tendon, in a sharp way is usually followed by a feeling of snapping and an immediate fall. Many times the patient explains that they believed someone had thrown a stone at them or hit them dry and turned to look. That is why we know this mechanism as
stone syndrome,
because it produces the same sensation.

What should we do if we suspect this break?

An Achilles rupture, or at least a suspicion of it, should always lead to a
medical service
without wasting much time. If the injury is complete it is worth evaluating the different treatments that we can offer, and if it is partial it should be treated and protected to prevent that injury from increasing. If we force ourselves to notice that feeling, we can only make what we have worse.

Should breaks be operated on or should they be treated conservatively?

This is a very important issue and on which at the Cugat Institute we always take special care. It will depend on the injury and the type of patient. If it is a complete or incomplete injury, if it affects an area very close to the calcaneus bone, if the rupture has occurred days, if not the first break of that Achilles, etc.

In short, in acute injuries in very active patients, surgery is usually recommended so runners (who want to keep running) will usually get the advice to have surgery from the doctor. However, there are also factors that depend on the patient. A patient with a rupture that can contact the edges, in a limb with important skin alterations that make surgery difficult for us, or vascular problems, is most likely to recommend a conservative treatment. In the case of
surgical option
is usually opted for, to get a faster recovery but each case is individualized.

Conservative treatments are usually performed with gypsum botins or orthopedic boots that allow us to carry out a wandering many times with the help of canes for a period longer than two months.

Surgical treatments usually consist of the suture of broken fragments. There are different surgical formulas, from direct suture, the use of grafts obtained from the same patient, donor grafts, etc. All of these techniques vary between surgeons as well as the type of injury and even the patient.

What about recovery?

It’s as much or more important than surgery. When we operate an Achilles we observe the condition of the tendon and get the idea why it’s broken. Sometimes the condition of the tendon tells us that there is a great degeneration. Well-worked tendons, with repeated tendinitis, with multiple infiltrations, or even the consumption of some type of antibiotics or anabolics, leave a tendon in a pitiful state that even make surgical management difficult. The quality of the suture we make will therefore set the pace of recovery. Then an early mobilization and a burden on that progressive limb are attempted. Each surgeon and team of specialists will set these rhythms.

The practice of the sport, as the race will therefore depend on the condition of said tendon, but it is very difficult to put on your shoes again before 16-20 weeks.

We must remember that after good physiotherapy we must make a progressive return to sport and for this we must think about sports rehabilitation. An injury of this type should make us change our training routines and incorporate in a much more important way elasticity exercises and propioceptives of the legs.

Can this injury be prevented?

A muscular and tendon state where we have a correct strength, elasticity and correct propioception also adapting the workload of the tendon to have a tendon as healthy as possible and decrease the risk of injury. Many runners continue with the same training routines for years, but their body is not the same. Recovery times are lengthened, and if not respected, our body takes its toll. We must be aware of the difficulties of our skeleton and we must adapt to its changes if we want to maintain our sporting level. Runners who want to maintain their running rhythms and distances should with age train more cautiously, balancing the load and with better muscle tone to avoid injuries that can stop their activity.

Dres. Roberto Seijas and David Barastegui

Specialists in Traumatology and Orthopedic Surgery from the Cugat Institute


Contact for medical questions about Traumatology and Rehabilitation.
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